| NPI | 1043876576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 16580) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 8094) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2024-05-31 |